A commentary on ‘Impact of intravenous dexmedetomidine on postoperative gastrointestinal function recovery: an updated meta-analysis’

Dear Editor,

Postoperative gastrointestinal dysfunction is a common consequence following abdominal and gynecological surgeries¹. It can cause reduced mobility, raising the risk of embolism and thrombosis. Longer hospital stays and higher healthcare expenses have also been linked to the incidence of postoperative gastrointestinal dysfunction, particularly when the dysfunction includes prolonged ileus. Additionally, postoperative ileus incidence ranges from 15% to 35%².

As a potent and highly selective alpha-2 adrenoreceptor agonist, dexmedetomidine is often utilized as an adjuvant anesthetic during surgical operations³. Dextmedetomidine provides unique organ protection by lowering the surgical stress response via its central sympatholytic along with anti-inflammatory actions. Moreover, its opioid-sparing effect decreases the requirement for perioperative analgesics. The presynaptic membrane on the postsynaptic membrane of the central nervous system and the membrane surface of intestinal smooth muscle cells are the primary locations for alpha-2 receptors. The activation of the parasympathetic nerve and the suppression of the sympathetic nerve are the primary mechanisms of gastrointestinal peristalsis. The pharmacological mechanism suggests that dexmedetomidine is useful in restoring gastrointestinal function following surgery.

The influence of perioperative dexmedetomidine administration on postoperative bowel function recovery was investigated by Lai et al.⁴ in an updated meta-analysis by investigating the time to first flatus in adult patients after noncardiac surgery. A meta-analysis of 22 randomized controlled trials (RCTs) involving 2566 patients revealed that the administration of dexmedetomidine was significantly linked to a shorter time to flatus, an earlier onset of oral feeding, a lower risk of postoperative nausea and vomiting, a quicker time to defecation, and a shorter hospital stay. However, the risk of postoperative pain score and hemodynamic instability remained unchanged.

We would like to provide a few recommendations to improve the study. First, the stability of the meta-analysis depends on an accurate quality evaluation. Meanwhile, the pooled results might be further refined through stratified analysis based on research quality. We discovered that the authors’ assessment of the risk of bias in the included reteaches was inaccurate during repeat validation. For instance, the original authors of the study by Sivaji et al.⁵ did not introduce the random sequence generating method; they only mentioned randomization. However, Lai et al.⁴ incorrectly set the randomization procedure to low risk. Second, there were comparable variations in the control group across trials, except for variations in the intervention group. As a result, the authors ought to draw attention to how different the control conditions were in terms of the nature and type of care given to the control group. Third, the evidence level of the findings should be evaluated in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE)⁶. Lastly, a significant geographical bias may have been introduced because the majority of the included RCTs were from Asia. Further research should be conducted in different countries and regions of the world to validate the effectiveness and safety of intravenous dexmedetomidine on the recovery of gastrointestinal function following surgery.

Ethical approval

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Consent

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Source of funding

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Author contribution

T.C.: wrote; J.S.: data collection; X.Q.: study design.

Conflicts of interest disclosure

The authors declare no conflicts of interest.

Research registration unique identifying number (UIN)

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Guarantor

Tao Cai.

Data availability statement

This is a letter to editor, a data statement was not necessary.

Provenance and peer review

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